That nurse was Michelle Reiss, PhD, RN, CS, assistant director at the University of Pittsburgh Medical Center School of Medicine. For the past 20 years, Reiss has been co-directing a residency program where she teaches physicians about the psychological aspects of medicine.

"What Randy and Jai experienced was heart-breaking and unimaginable, and yet they did so with such grace and courage," said Reiss. "The psyche issues confronting cancer patients create different forces coming together at the same time. Initially, I went to their home to meet their children to understand where they were developmentally in order to guide Randy and Jai through the process of preparing their children."

Michelle Reiss, PhD, RN, CS, assistant director at the University of Pittsburgh Medical Center School of Medicine, helped Randy and Jai Pausch cope with the psychological affects of his terminal illness.

Reiss helped Jai prepare financially and emotionally for life without her husband, and worked on setting up systems so their three young children - Dylan, Logan and Chloe - would be able to remember their father.

"Randy's book was a legacy for his children," said Reiss. "The family now has a book they can read and a video (the original "Last Lecture" Pausch gave at Carnegie Mellon) they can watch. It was important for Randy to teach them what he wanted them to learn."

And with Reiss by their side, Jai learned how to make the best decisions at the time, prepare their three young children for their father's imminent death, balance and prioritize the couple's time together and how not to let fear paralyze her every move.

At the advice of Reiss, Jai made note cards to practice the words to say to her sons.

"When Randy became visibly sick, Dylan began asking a lot of questions," said Jai. "Unfortunately, it was around Father's Day in June. I asked Dylan first if he knew what was wrong with Daddy and when he said 'no,' I asked him if he wanted to know and he said, 'yes.'

 "I told my son, 'Daddy's cancer is back and he is very sick.' I explained the cancer is beating the medicine, Daddy's heart will stop beating, he will stop breathing and then he will die."

Jai said she talked to both of her sons individually, and shared with them, "You didn't cause the cancer and you can't make it go away."

Ultimately, Reiss said children need to be reassured they will be well taken care of regardless of what happens.

"They need to know they will be OK," she said. "Like all kids, it comes down to, 'What's going to happen to me?' They need consistent and constant reassurance."

Understanding the various phases of the dying process is one of the most challenging aspects of teaching the dying process to children.

"The concept of death is age-dependent and must be developmentally consistent for each child," explained Reiss. "With three different children, there were three different stages."

Changes in Lifestyle

One of the most difficult aspects for Randy was coming to grips with the idea that his health was slowly deteriorating, Reiss said.

"Randy was physically active for a long time," she said. "Reconciling the discrepancy of being in good shape before diagnosis and yet being very sick was very difficult."

Reiss said Randy and Jai's mantra soon became, "Hope for the best, but prepare for the worst."

"Understanding your treatment options and feeling hopeful is a constant paradox because you feel well, but you're dying," explained Reiss. "Randy and Jai were told pancreatic cancer killed quickly but Randy was willing to do aggressive treatments and therapies."

Preparing for Death

"During the third phase, Jai and I went to prepare for Randy's funeral arrangements," shared Reiss. "The questions were, 'What are the priorities?' 'What needs to get today?'"

During this time, Randy told Reiss he wanted other people to "have the counsel you gave us."

So Reiss started writing, Lovely Lights, which will be published early next year. Reiss said the book is a compilation of years of advice to her clients who she calls "heroes." But Reiss said it was the Pausches who inspired her to reach a broader audience.

"Randy taught us to love life and don't let anything stop you from fulfilling your dreams," shared Reiss.

Amy McGuire is a regional editor at ADVANCE.